Debra began her professional career as a Registered Nurse, specializing in the adult critical care area. Shortly thereafter Debra joined the critical care clinical research team at Toronto General Hospital. While there, Debra was the project lead for a multi-national, multi-center clinical trial, the MEDIC study. The data was used for a successful 510k de novo submission to the FDA for the Endotoxin Activity Assay (EAA). It was the first IVD in the field of sepsis. Debra went on to follow the device to its commercial partner, as an employee of Spectral Medical. She was appointed Vice President of Clinical Development in 2011. Debra has led many clinical research projects, including the EUPHRATES and TIGRIS clinical trials for a device to treat patients with endotoxemic septic shock. In December 2021, Debra opted for partial retirement and remains a clinical consultant for Spectral Medical. Debra has lectured many times to medical professionals on the topics of sepsis and clinical trials for sepsis. She has been a co-author of more than 50 articles in peer-reviewed journals and lectured for academic and industry audiences.
The mechanisms of the damaging effects of endotoxin on renal function are complex but, in essence, involve dysregulated inflammation, oxidative stress, microvascular dysfunction and poor clearance of endotoxin burden. In both acute and chronic kidney dysfunction high levels of endotoxin are associated with a higher risk of mortality.
Measurement of endotoxin (lipopolysaccharide) in human whole blood has been difficult, in part due to the fact that the conserved active portion of the lipid A molecule is only amenable to binding by a single ligand. The endotoxin activity assay [EAA], is a bioassay based on neutrophil activation by complement opsonized immune complexes of lipopolysaccharide (LPS) and a high affinity IgM antibody. This assay permits detection of the lipid A epitope of LPS in a rapid whole blood assay format. The EAA is approved for use by Regulatory bodies in many regions including the US, Europe, Asia, and Japan. It can be performed in a unit dose format with result generation in 30 minutes and is suitable for patient triage and selection for anti-endotoxin therapy. The EAA has been used identify endotoxic septic shock (ESS) as a phenotype that is characterized by high endotoxin activity in addition to a high burden of organ failure; including hepatic dysfunction, acute kidney injury, and various forms of endothelial dysfunction. ESS is a subset of sepsis with a 28-day mortality that exceeds 40%.
While many drug development companies seek an endotoxin removal strategy, an alternative is via an extracorporeal hemoperfusion cartridge that selectively removes endotoxin from circulating blood. The PMX cartridge (TORAYMYXIN PMX-20R [adult], and TORAYMYXIN PMX-05R [pediatric]) utilizes the antibiotic polymyxin B, which is bound and immobilized to fibers within a cartridge and administered by veno-venous hemoadsorption. Studies using the EAA to identify patients with ESS and treating with polymyxin B hemoperfusion, have shown to be a safe and effective intervention in patients with acute kidney injury to improve survival.
Huang Wei Ling, born in Taiwan, raised and graduated in medicine in Brazil, specialist in infectious and parasitic diseases, a General Practitioner and Parenteral and Enteral Medical Nutrition Therapist. Once in charge of the Hospital Infection Control Service of the City of Franca’s General Hospital, she was responsible for the control of all prescribed antimicrobial medication and received an award for the best paper presented at the Brazilian Hospital Infection Control Congress in 1998. Since 1997, she works with the approach and treatment of all chronic diseases in a holistic way, with treatment guided through the teachings of Traditional Chinese Medicine and Hippocrates. Researcher in the University of São Paulo, in the Ophthalmology department from 2012 to 2013.Author of the theory Constitutional Homeopathy of the Five Elements Based on Traditional Chinese Medicine.
Introduction: Benign prostatic hyperplasia is a condition characterized as a bladder overflow obstruction causing lower urinary tract symptoms. It affects aging men.
Purpose: The purpose of this study is to demonstrate that patients with benign prostatic hyperplasia have energy deficiency inside the five internal massive organs (Liver, Heart, Spleen, Lungs, and Kidney) leading to enlargement of the prostate.
Methods: The methods through three case reports of 72, 49, and 49 years old male patients with a diagnosis of benign prostatic hyperplasia. I measured the energy of the five internal massive organs using a radiesthesia procedure.
Results: All patients were in the lowest level of energy, rated one out of eight. The treatment of this condition using Chinese dietary counseling, auricular acupuncture with apex ear bloodletting and systemic acupuncture, and using highly diluted medications according to the theory of Constitutional Homeopathy of the Five Elements Based on Traditional Chinese Medicine, improved their clinical condition quickly in one week, without the necessity of using another type of treatment.
Conclusion: The conclusion of this study is that patients with benign prostate hyperplasia have energy deficiency inside the five internal massive organs and the use of tools to regulate and replenish these energies using highly diluted medications according to the theory of Constitutional Homeopathy of the Five Elements Based on Traditional Chinese Medicine.
Mahmoud Nady Abd El Aziz Abd El Azim is a lecturer of internal medicine and nephrology faculty of medicine at Ain Shams University. He holds an MD in internal medicine and nephrology and is a member of ESNT. Mahmoud has 11 years of experience in nephrology and renal transplantation. He is currently the Head of the nephology and dialysis unit at Ain Shams University Cardiovascular Hospital. He has conducted many studies in the field of nephrology and is currently teaching internal medicine and nephrology in the faculty of medicine and supervising many studies in the same fields.
Uremic pruritus is a common discomfort in end- stage renal disease patients on long-term hemodialysis. It negatively affects patients’ quality of life and is associated with increased mortality. The pathogenesis of uremic pruritus is complex. Aluminum is a toxic metal and common human allergen that causes an immune reaction in patients on hemodialysis. Aluminum is hypothesized to play a vital role in the pathogenesis of uremic pruritus. Controlling serum aluminum levels is still critical for patients on long-term hemodialysis. our Objectives was to determine the prevalence of hyperaluminemia and assess its correlation with uremic pruritus in patients on long-term hemodialysis.
We conducted a case-control study on 90 patients on long-term hemodialysis at the dialysis units of Ain Shams university hospitals. We used the 5-D itch scale numerical rating system to determine the presence and severity of pruritus in our study participants. We collected blood samples to estimate blood urea nitrogen levels pre- and post- dialysis, as well as the measured urea reduction ratio, serum creatinine, hemoglobin level, intact parathyroid hormone, ionized calcium, serum phosphate levels, iron study and serum aluminum levels.
Our study showed no statistically significant differences between the pruritic and nonpruritic study groups (median values 9.78 [6.48–11.72] and 9.13 [6.3–10.4] for the pruritic and non-pruritic groups, respectively; P = 0.32). We concluded that The serum aluminum levels of our study participants were higher than the normal levels in humans. Patients in the pruritic group had higher levels than those in the non- pruritic group. However, aluminum levels were not significantly associated with either the presence or severity of pruritus in patients on long-term hemodialysis.
Maria Fernanda Naufel Graduated as a Dietitian, specialist, and master in Nephropediatry and PhD in Nutrition from Universidade Federal de São Paulo (UNIFESP). She has professional experience focusing on Clinical Nutrition, acting on the following subjects: gut hormones, obesity, sleep and mood disorders, nephrology, and postmenopause. Dr. Naufel is a postdoctoral researcher at the UNIFESP and a researcher assistant at Instituto do Coração (InCor HCFMUSP).
Besides, she is a dietitian with 19 years of clinical experience. She has a deep knowledge of clinical nutrition fields, working on topics related to obesity, sleep disorders, depression, anxiety, gut hormones, insulin resistance, post-menopause, and chronic kidney disease.
The human gut microbiota is a complex and diverse community of microorganisms that various factors such as diet, metabolism, age, geography, stress, seasons, temperature, sleep, and medication can influence. Recent research has suggested a strong and reciprocal relationship between the gut microbiota and the brain, indicating that an imbalance in the gut may play a crucial role in the development, function, and disorders of the central nervous system.
Various mechanisms explain how gut-microbiota interactions affect neuronal activity. The vagus nerve, endocrine, immune, and biochemical pathways mediate the brain-gut-microbiota axis. Dysbiosis of the gut microbiota has been linked to neurological disorders through activation of the hypothalamic-pituitary-adrenal axis, neurotransmitter imbalance, systemic inflammation, and increased intestinal and blood- brain barrier permeability.
With the COVID-19 pandemic, the prevalence of mental and neurological diseases has increased globally, including among patients with chronic kidney disease (CKD), making it an essential public health issue. Since an imbalance in the gut microbiota is a significant risk factor for neurological disorders, it is crucial to understand the importance of diagnosing, preventing, and treating dysbiosis, which is commom in CKD. This review provides a summary of evidence demonstrating the influence of gut dysbiosis on mental and neurological disorders.
Kartik Ganesh is a nephrologist and renal transplant physician at a leading private hospital in South India. He has completed his training in Nephrology (DM) in the reputed Amrita Institute of Medical Sciences, Kochi. He has worked in Nephrology for the past 8 years and has managed more than 500 transplant cases. In addition, he has published numerous papers in national and international journals of repute and has co-authored an atlas of renal transplant pathology. He has also contributed to multiple textbooks of nephrology and critical care. He is also passionate about teaching. His areas of interest include critical care nephrology and renal transplantation.
BK virus nephropathy (BKVN) is an emerging cause of early graft dysfunction post kidney transplant. The prevalence in kidney transplant recipients has been described to be up to 25%â€“30% (viruria) and 12% (viremia). Viruria and viremia are usually followed by nephropathy. Historically, BKVN has been associated with a significant graft loss amounting to as much as 50%. Detection and management can be challenging, and historically, there is a high chance of graft loss BK virus reactivation occurs in immunosuppressed patients. It is frequently subclinical and needs a high index of suspicion. Treatment options are limited. Thereby preservation of graft function from the deleterious effects of BK virus assumes great importance.Â Reduction in immunosuppression is the basis of therapy in BKVN. Specific management strategies are so far lacking which makes management of these cases challenging. Reducing the intensity of maintenance immunosuppression currently represents the primary mode of intervention. However, protocols and success rates are heterogeneous.
Our group at VPS lakeshore Hospital, Kochi, Kerala is a major kidney transplant centre in South India. We have completed more than 1600 kidney transplants including challenging retransplants, transplantation in highly sensitized patients and ABO incompatible transplantation. Our experience with BK virus has been an evolving one. Various therapeutic regimens for established nephropathy have been used- ranging from an initial â€˜kitchen sinkâ€™ treatment protocol, to a more tailored regimen at present. The cornerstone of management is reduction of immunosuppression. We tested two treatment protocols, both involving intravenous immunoglobulin at different doses and intervals. Both these protocols were analysed, compared and contrasted. In addition, lessons learnt regarding induction immunosuppression, relapses of BK Virus after treatment and interesting cases like BK virus encephalitis (first Asian report), missed BK virus nephropathy, and the role of nephrectomy will be discussed on a case by case basis. We have also drawn correlations between histopathological class and graft survival. Our current research work in this field involves a study of prevalance of BK virus in donors (and by proxy in the general population), and to assess the impact of that on the development of BK virus nephropathy in the matched recipient pair.
Certified in HIV education (HEAT), women's reproductive health, and safe abortion access (WRHSA IPAS), and medical education advocacy (AMET), and International Peer Education Training (IPET) I bring extensive training experience having facilitated more than 50 workshops.
Currently pursuing a residency in Internal Medicine post-graduation from the Université Libre de Bruxelles, my 7-year clinical journey spans Morocco, France, and Belgium. Engaging in public health initiatives, I held key roles at the International Federation of Medical Student Associations , including Director of Capacity Building for Sexual and Reproductive Health and Rights, President of the Supervisory Board and National Coordinator for Health and Rights in Morocco.
Beyond medicine, I contributed to impactful projects like the UNAIDS response system evaluation, and authored policy development manuals for IFMSA. My passion for music complements my commitment to healthcare, advocacy, and creativity.
In addition to these pursuits, I bring a year of part-time work in a Laboratory of Experimental Nephrology, adding depth to my holistic approach. This experience aligns with my profound passion for nephrology, enhancing my broader dedication to healthcare, advocacy, and creative pursuits. With a global outlook and multifaceted expertise, I am poised to contribute meaningfully to healthcare and its evolving landscape.
In patients hospitalized for severe COVID-19, the incidence of acute kidney injury (AKI) is approximately 40% 1. To predict and understand the implications of this complication, various blood and urine biomarkers have been proposed 2,3, including neutrophil gelatinase-associated lipocalin (NGAL), chemokine (C-C motif) ligand 14 (CCL14), cystatin C, leucine aminopeptidase (LAP), and soluble urokinase plasminogen activator (suPAR) . This study, conducted between mid-January and early May 2021, aimed to assess the diagnostic and prognostic capabilities of these biomarkers in a cohort of COVID-19 patients monitored during the initial two weeks of hospitalization. Among the 116 patients included in this study, 48 developed AKI within the first three days of hospitalization (41%), with 29 requiring intensive care unit (ICU) admission, and the overall mortality rate was 18%. AKI patients exhibited a statistically significant increase in urinary LAP levels, indicating acute tubular injury as a potential mechanism underlying COVID-19-related renal damage. Conversely, urinary NGAL and CCL-14 excretion rates did not differ significantly between the AKI and non-AKI groups. Importantly, elevated plasma suPAR and cystatin C levels upon admission per-sisted throughout the first week of hospitalization and were associated with unfavorable out-comes, such as prolonged ICU stays and increased mortality, irrespective of AKI development. In conclusion, this study underscores the early predictive value of urinary LAP levels in identifying acute tubular injury in COVID-19-induced AKI. Moreover, elevated plasma suPAR and cystatin C levels serve as valuable prognostic markers, offering insights into the short-term morbidity and mortality risks among COVID-19 patients, regardless of AKI occurrence. These findings shed light on the complex interplay between COVID-19, renal injury, and biomarkers with diagnostic and prognostic potential.
Samra Farid Musaed Hussein is a dedicated lecturer at the College of Applied Studies and Community Service - Health Programs, King Saud University, Riyadh, Saudi Arabia. With expertise in qualitative and quantitative analysis, academic writing, research methodology, and data collection, Samra excels in research analysis, interviewing, and article writing. Their commitment to excellence in methodology and data analysis contributes significantly to the academic community.
In the past thirty years, the Kingdom of Saudi Arabia (KSA) has experienced a dramatic shift in its epidemiology and nutrition, leading to a widespread outbreak of non-communicable diseases and a notable rise in illness and death caused by diabetes. In addition to nephropathy, diabetic retinopathy is the most common microvascular complication of diabetes. The study investigated the correlation between diabetic retinopathy (DR) and nephropathy, considering their interconnection. Chronic elevation of blood sugar levels and widespread inflammation in the body increase the likelihood of developing diabetic retinopathy (DR) and nephropathy. Individuals with diabetes may experience concurrent renal and ocular microvascular impairment. In addition, a study carried out in Saudi Arabia on patients with diabetes found that nephropathy significantly influenced the probability of diabetic retinopathy in type 1 diabetes mellitus. Therefore, gaining knowledge and properly predicting the concurrent progression of these problems should improve the management and comprehension of diabetes' systemic influence on several organ systems. Hence, the aim of this study is to develop inclusive prognostic models that consider both diabetic retinopathy (DR) and nephropathy in individuals diagnosed with type 1 diabetes mellitus (T1DM), with the objective of improving the precision of clinical progression forecasts. This research topic encompasses several components, including multimodal data fusion, sophisticated machine learning, longitudinal analysis, and risk stratification, in order to accomplish its objective. This Integrative Predictive Models ensures that the research is thorough and has a significant impact. The Multimodal Data Fusion study aims to explore techniques for combining several forms of data, including retinal pictures, electronic health records, and genetic information, in order to provide a comprehensive dataset for the purposes of training and validating models. The study will evaluate and analyse the effectiveness of cutting-edge machine learning algorithms, including deep learning models, ensemble approaches, and explainable AI techniques, in forecasting the advancement of both diabetic retinopathy and nephropathy. Create risk stratification models to identify certain subgroups with an elevated risk of concurrent progression of diabetic retinopathy and nephropathy. This will enable the implementation of individualized interventions and treatment strategies. Longitudinal research will be done at two diabetic centers in Riyadh to capture temporal patterns and trends in disease progression, so facilitating more precise predictions over time. The patients' data will consist of demographic information and clinical features, including hypertension, Hemoglobin A1c (HbA1c), nephropathy (Serum Creatinine Levels, Estimated Glomerular Filtration Rate (eGFR), and Urinary Albumin-to-Creatinine Ratio (UACR), recorded in their electronic medical records. The retinal data is assessed by fundus photography and classified 24, Dec 2023 into five categories: No diabetic retinopathy, nonproliferative retinopathy, Mild nonproliferative retinopathy, severe nonproliferative retinopathy, and proliferative retinopathy.
Keywords: Diabetes, Diabetic Retinopathy, Nephropathy , Multimodal Data Fusion, Machine Learning, Longitudinal Analysis, Risk Stratification, Integrative Predictive Models.
Ayman S. AbuTair is a head of clinical nutrition department at Naser medical complex 2021- now. Lecturer at AUG 2018-now. Holds master degree in clinical nutrition from AUG 2016. PhD student at SARAWAK University. His primary research interests are in NCDs, nutrition assessment, obesity, nutrition and metabolic diseases, malnutrition, nutrition and critical illness. He is a recipient of many awards and grants for his valuable contributions and discoveries in major area of subject research. He is one of the participants in writing the National Nutrition Protocols and Manual. He has published numerous articles on different area of nutrition. Attending and participating in many local and international conferences.
Malnutrition is a common condition in patients undergoing hemodialysis (HD), and it is associated with increased morbidity and mortality. The main objective of the study was to evaluate the nutritional status of patients on maintenance HD. After applying eligibility criteria, 141 HD patients attending major governmental dialysis centers were randomly recruited in this cross-sectional study and assessed for nutritional status using the Patient-Generated Subjective Global Assessment (PG-SGA) tool. The PG-SGA categorizes patients as well-nourished, moderately malnourished, and severely malnourished. Different anthropometric measurements, laboratory investigations, blood pressure measurements, and 24-h dietary recall were collected from each patient. According to PG- SGA results, 78% of patients were moderately malnourished and 22% of patients were severely malnourished. The mean body mass index was 27.8 kg/m2, and 5.7% of patients were underweight. There were significant differences in the mid-upper arm muscle circumference (P = 0.020) between the PG-SGA groups. The total energy and protein intake were significantly (P <0.001) less than the recommended dietary intake by 1268.9 kcal and 41.4 g, respectively. The albumin level in 37.6% of patients was less than the normal level, and the results indicated that there were significant differences in serum iron (P = 0.022) between the moderately and severely malnourished patients. The results of this study indicated that all HD patients were suffering from different degrees of malnutrition and, unfortunately, most of their energy and nutrient intake was far less than the requirements, which might be the reason why they face nutritional and health risks.